Toolkit for Modifying Evidence-Based Practices to Increase Cultural Competence

Wendy Schudrich, LMSWCharles Auerbach, PhD, LCSW-RYeshiva University, New York, NY

Presentation TopicsDevelopment of the Toolkit Overview of the methodologyHow has the Toolkit been used?Community benefitsFuture activitiesQuestions?

Toolkit Development

Developed with funding from NKI Center of Excellence in Culturally Competent Mental Health Study the intersection of mental health and culture Develop tools to help agencies achieve a high level of

cultural competence in the delivery of services Train agencies and practitioners to apply tools within their

organizations with the goal of engaging consumers and improving outcomes

Multidisciplinary collaboration

The Need to Modify EBPs There is a need for effective mental health interventions for

cultural groups EBPs have not been developed with cultural groups in mind EBPs have been developed, but not tested for effectiveness for specific

cultural groups EPBs have been developed and tested for specific cultural groups, but

materials such as training manuals do not reflect the breadth of cultures served

SAMHSA’s registry of EBPs include a growing list of effective interventions

There is no systematic method for considering modifications to EBPs for cultural groups

An Overview of the Process

Working with CommunitiesGoals: Increase knowledge about cultural groups and

their mental health needs Increase acceptance of services

Community involvement hinges on the development and work of a working group:

Determining who to work with and why Working together on modifications Working through implementation issues

Selecting an EBP1. Identify possible EBPs

2. Evaluate the cultural appropriateness of EBPs Determining cultural fit Pragmatic considerations Identifying the need for cultural modifications

3. Making a final decision

Modifying EBPs1. Breaking down the EBP into components using the

helping process model and determining which components to modify

2. The process of modification

3. Documenting modifications

4. Piloting the modified EBP

5. Evaluating the success of the modification

A Framework for Identifying Components

Engagement Work Termination/Discharge

Access Specific cultural factors

Toolkit Tables

Implementation Issues

Evaluating organizational readiness for change

Evaluating the organization’s current level of cultural competence

Final implementation

Other resources in the ToolkitChecklist and workbook to help users complete the

process

Annotated bibliography

Specific instruments for helping organizations change: Organizational cultural competency Organizational readiness for change In progress – program-level measure of cultural

competence

NKI Conducted Implementation Study at these 2 AgenciesWe provided:Training at each agency to provide an overview of

the methodologyAll existing Toolkit materials Technical assistance throughout the projectIn exchange:Attended all meetings related to the cultural

modification projectReceived all agency-based exchanges (e.g., notes,

e-mails, handouts) that were a product of the project

Use of the Toolkit in Practice Agency 1 – largest social service agency in a large

northeastern city. Problem to address: large number of Russian speaking seniors

presenting with symptoms of depression

Agency 2 – large provider of social services in predominantly urban/suburban region. Problem to address: poor participation among African-

Americans in an existing evidence-based parenting program in a small upstate city.

What We Have Learned Agencies can do this with Master’s-level staff! Initial training for agency staff was critical for understanding the

methodology and the scope of the project While agencies do work with community members, forming the

working groups proved challenging Identifying a constellation of group members that was appropriate Getting away from mental/behavioral health Figuring out how to explain the project in layperson’s terms and

asking for participation Learning to identify possible EBPs required more skills than

some agency staff had The process can be streamlined based upon agency and

community needs – 3 meetings with working group seems sufficient

Agencies and community members appreciated the project“It [the Toolkit project] was helpful. We got feedback about what the community needs…. The Toolkit process gave us direction and resources and strategies.”

- Project Lead

“I was skeptical at first. The community wasn’t asking for this. I felt it was our idea, and I had my doubts. Now I understand that there is rampant discrimination. This process has helped me understand what is going on in your community.”

- Agency working group member

“The project was really helpful to us. We are planning to repeat the process in the Latino community.”

- Director of Social Services

Follow-ups:The Toolkit and Workbook should be updated to

reflect useful examples from the implementation study.

Continue to provide technical assistance and begin to create a learning community for those doing cultural modifications.

Study the degree to which cultural modifications using the Toolkit methodology improve outcomes for clients.

Questions?Thank you!

Wendy Schudrich – schudric@yu.eduCharles Auerbach – auerbach@yu.edu

To access the Toolkit and Workbook: http://ssrdqst.rfmh.org/cecc/index.php?q=node/86